Provider Demographics
NPI:1811004484
Name:IWUAGWU, NOBLE CHUKWUEMEKA (MD)
Entity type:Individual
Prefix:DR
First Name:NOBLE
Middle Name:CHUKWUEMEKA
Last Name:IWUAGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CREEKRISE DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4801
Mailing Address - Country:US
Mailing Address - Phone:706-535-1565
Mailing Address - Fax:
Practice Address - Street 1:150 CREEKRISE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4801
Practice Address - Country:US
Practice Address - Phone:706-535-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58252207RN0300X
GA058252208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003159140AMedicaid